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Home My WebLink AboutTR-6957A James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE __ Pre-construction, hay bale line __ 1st day of construction ½ constructed __ Project complete, compliance inspection. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6957A Date of Receipt of Application: September 5, 2008 Applicant: Joan Saunders SCTM#: 123-3-18 Project Location: 1375 Bungalow Lane, Mattituck Date of Resolution/Issuance: September 17, 2008 Date of Expiration: September 17, 2010 Reviewed by: James F. King, Trustee President Project Description: Hand trim the phragmites to no less than 12 inches in height on an as needed basis. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the application prepared by Joan Saunders, and received on September 5, 2008. Special Conditions: None. Inspections: Final inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. James F. King, President Board of Trustees JFK:eac James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Please be advised that your application dated ~t,,~P_~' .~ ~c~" has been reviewed by this Board at the regular meeting of"' and your application has been approved pending the ¢orn'pletion of the following items checked off below. __ Revised Plans for proposed project __ Pre-Construction Hay Bale Line Inspection Fee ($50.00) __ 1st Day of Construction ($50.00) __ ½ Constructed ($50.00) Final Inspection Fee ($50.00) __ Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as §et forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: BY: James F. King, President Board of Trustees oo / 2B 42.B~ktcl 125 NO. oo / 125 125 SEP - 5 2008 Southhold Town Beard of Trustees 42.BM¢1 5 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob ~nosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office UseOnly Erosion Permit Application ~~' Coastal ~Wetland Permit Application ~--Administrative Permit Amendment/Transfer/Extension b~eeC~d Application: t~ ceived Fee:$ _~-O~g~' ' ' Completed Application Incomplete SEQRA Classification: Type I Type II Unlisted ___Coordination:(date sent) LWRP Consistency Assessment Form ~CAC Referral Sent: Date of Inspection: Receipt of CAC Report: __Lead Agency Determination: Technical Review: ~Public Hearing Held: ~ Resolution: Name of Applicant .~/[).,L/~_A(.'""PhoneNumber:(~) ~q~' ~/ Suffolk County Tax Map Sumber: 1000- ¢~88~ I~'~-[~ mrope~y Location: ~OL~ ~ Il ~~ ~- (provide LILCO Pole ~, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: of Trustees Applicatio~ GENERAL DATA Land Area (in square feet): ~,,/~ ~C Area Zoning: ~c~l~k)'~l ~l..-. Previous use of property: Intended use of property: Covenants and Restrictions: If "Yes", please provide copy. Yes No Prior permits/approvals for site improvements: Agency Date __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspend~t by a governmental agency? t/ No Yes If yes, provide explanation: Project Description (use attachments ifnecessary):% T/~! ~ ff'/t/~/t~(~j-I//~-s rd of Trustees Applicati¢ WETLAND/TRUSTEE LANDS APPLICATION DATA Purposeoftheproposedoperations: ~'~ ~]~'~ ~[']l~ Area of wetlands on lot: .square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and uplan edge of wetlands: feet Does the .~9ject involve excavation or filling? ./ V No Yes If yes, how much material will be excavated? How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited:~ Statement of the effect, if any, on the wetlands and tidal wa_t_ers_ of the town that may result by reason of such proposed operations (use attachments if appropriate): PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1. APPLICANT / SPONSOR 3.PROJECT LOCATION: PRECISE 1575 617.20 SEQR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or orovide map IS PROPOSED ACTION: [~ New [] Expansion [] Modification / alteration DESCRIBE PROJECT BRIEFLY: o,':/,,uV,¢61 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~[~.Yes [] No If no, describe briefly: 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply ) ~'Residential E~] Industrial I~ Commercial []Agriculture [] Park / Fores, / Open Space ] Olher (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. AGENCY (Federal, State or Local) ~lYes ~ No if yes, list agency name and permit / approval: NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL 11. OO~.~ A~IY A~PeCI OF tHE ACTION HAVE A C]JRREN~'-LY VALID PERMIT OR APPROVAL? ]Yes E~No If yes, list agency name and permit / approval: 12j~YesAS A .R~ULTN° OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? CERTIFY THAT THE iNFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant '~e 4Signalure · d~ If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead A~lenc¥) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL FAF. E]Yes r~No WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. F'~ Yes F~No c. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, sudace or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A commun y's ex s ng p aris or goa s as off c a y adopted, or a change n use or nens y of use el land or other natural resources? Explain briefly: Growth subsequent development or related actwd~es I~kely to be reduced by the proposed a~tion? Explain briefly: C6. k~g torm, short term, cumulafive, or other effecis' not identified ih D1-C57 Explain 'h~iegy: C7. Other ~rnpacts Onclud~ag changes ~n use of e~ther quanbty or type of energy¢ Explain bdeti¥: D. WiLL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL E. IS THERE. OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?; If ~es explain' PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, ~mportant or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (0 magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked y e-sAhedeterminat k)n of s ignificancemust evaluate the po tentiat~ mpa6t cf th c pre p cscdaefion on t heef~ironm,,ent~l characteristics of th ~ C FA. Check this box if you have identified one or more potengally la rge or significant adverse impacts which MAY occur. Then proceed directly to the FULl FAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed acfie~ WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency Date Title of Responsible Officer Pdnt or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from responsible officer) ~oard of Trustees Application County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES 1N CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS DAY OF ,20 Notary Public of Trustees Applicat: AUTHORIZATiON (where the applicant is not the owner) (print owner of property) residing at (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (Owner's signature) 8 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nrohibits conflicts of interest on the vart of town Officers and emolovees. The ouruose of this form is to omvide information which can alert the town of ~ossible conflic~ of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: (Last name, firs~[u~e,-ga{ddle initial, unless you are applying in the name of someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If "Other", name the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns reom than 5% of the shares. YES NO lfyou answered "YES", complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent, or child is (check all that apply): __A) the owner of greater than 5% of the shares of the corporate stock of the applic0nt (when the applicant is a corporat/on); __B) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); __.C) an officer, director, partnei', or employee of the applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submitted th~s,~ay o~00~_ Signature ~. ~,~ PrintNa~o/ ~1~3 ~. 6/:/0~0~'~,~--.~